Expertise in physiological breech birth: A mixed‐methods study

Walker, Shawn; Parker, Pamela; Scamell, Mandie

doi:10.1111/birt.12326

Cited by 32 publications

(32 citation statements)

References 25 publications

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“…Most probably obstetricians are now more confident because of the existence of the breech clinic and of an updated common local protocol. As Walker et al (26) suggest in their study, the expertise is developed by, among others factors, 'confidence and competence among colleagues' and the clinicians who have an interest in breech births should be supported within specialist teams. We also believe the different sessions with doctors and midwives to prepare the breech birth enhance the woman's confidence in the breech delivery.…”

Section: Discussionmentioning

confidence: 99%

Impact Of Implementation Of A Breech Clinic In A Tertiary Hospital

Derisbourg

Costa

Luca

et al. 2020

Preprint

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BACKGROUND Breech presentations concern three to five percent of singleton pregnancies at term. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 at the ‘Hôpital Universitaire Erasme’. The primary objective of this study is to compare the vaginal delivery rates before and after the implementation of the breech clinic. The secondary objective is to compare the early neonatal outcomes before and after the breech clinic was introduced. METHOD This is a monocentric retrospective and prospective study. The inclusion criteria were term (from 37 weeks) singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbi-mortality. RESULTS After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.04% (61/115) (OR: 13.5; 95%CI: 6.7-27.04). The effective vaginal breech delivery rate (planned and unplanned) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95%CI: 7.3-39.6). CONCLUSION The implementation of a breech clinic has led to an increase in vaginal deliveries for breech babies.

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Section: Discussionmentioning

confidence: 99%

Impact Of Implementation Of A Breech Clinic In A Tertiary Hospital

Derisbourg

Costa

Luca

et al. 2020

Preprint

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“…It is however plausible that our obstetricians and midwives, those directly working in the breech clinic and those not directly working in it, are now more con dent in considering an attempt at vaginal birth, due to the existence of the clinic, the presence of an updated local protocol and the 24 hours a day and 7 days a week on-call breech clinic dedicated obstetricians. As Walker et al (19) suggest in their study, the expertise is developed by, among others factors, 'con dence and competence among colleagues' and the clinicians who have an interest in breech births should be supported within specialist teams. We also believe that the special preparatory sessions with doctors and midwives to discuss and plan their breech birth help to enhance women's con dence in the breech delivery process.…”

Section: Discussionmentioning

confidence: 99%

“…In order to support eligible women in their choice of mode of delivery, and to standardise care and counselling (18), a 'breech clinic' with a dedicated care pathway and a vaginal breech protocol were developed in our unit starting from December 2015. In order, to effectively support women and clinicians, a 24-hour on-call specialist team was also established as suggested by Walker et al (18) (19).…”

Section: Evaluated the International Federation Of Gynecology And Obmentioning

confidence: 99%

Impact of Implementation of a Breech Clinic in a Tertiary Hospital.

Derisbourg

Costa

Luca

et al. 2020

Preprint

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BACKGROUND The incidence of breech presentation in single pregnancies at term is between three to five percent. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced. METHODS This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality. RESULTS After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95%CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95%CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods. CONCLUSION The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes .

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“…The incorporation of normal birth updates into periodic mandatory skills training for all staff, alongside refreshers in emergency skills, has been suggested by other research concerning midwives' confidence with physiological birth (Nicholls et al, 2016, Rayment et al, 2015, and may be another direction for future research. (Walker et al, 2017). Research indicates that communities of practice are dynamic social structures which require cultivation over a period of time (Cambridge et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

‘Keeping birth normal’: Exploratory evaluation of a training package for midwives in an inner-city, alongside midwifery unit

et al. 2018

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a review of evidence, local statistics and practical skills using active educational approaches was important to this training. Two factors not directly related to content appeared equally important: catalysing a community of practice and the perceived power of workshop leaders to influence organisational systems limiting the agency of individual midwives. Cyclic, interactive training involving consultant midwives, senior midwives and the multidisciplinary team may be recommended to be most effective.

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Expertise in physiological breech birth: A mixed‐methods study

Abstract: Specialist breech teams may facilitate the development of expertise within maternity care settings. Evaluation of expertise based on enablement of women and colleagues, as well as outcomes, will potentially avoid the pitfalls of alienation produced by some forms of specialist authority.

Cited by 32 publications

References 25 publications

Impact Of Implementation Of A Breech Clinic In A Tertiary Hospital

Impact Of Implementation Of A Breech Clinic In A Tertiary Hospital

Impact of Implementation of a Breech Clinic in a Tertiary Hospital.

‘Keeping birth normal’: Exploratory evaluation of a training package for midwives in an inner-city, alongside midwifery unit

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